Catatonia in psychotic disorder

Psychosis plus marked motor syndrome

EmergentReview due

At a glance

High-risk causes: 4
Core tests: 5
Immediate actions: 6
Related differentials: 5

Safety snapshot

Watch forViolence in excited catatoniaprofound immobilityrefusal of intakeautonomic instability

Presentation hinge

Characteristic motor syndrome rather than simple low mood, psychosis, or "behavioural refusal". Mood disorders are a very common substrate.

Separates the Catatonia / Psychomotor Shutdown / Malignant Syndromes group. It is not specific to Catatonia in psychotic disorder.

Points for this presentation

Applies to the Catatonia / Psychomotor Shutdown / Malignant Syndromes group — not specific to Catatonia in psychotic disorder

Use structured screen (Bush-Francis), examine motor signs, check vitals/hydration/CK, think benzodiazepine challenge early
Catatonia is more often mood-linked than many clinicians expect
Treat the catatonia specifically
Benzodiazepines and/or ECT are first-line

Clinical review

Rows marked “Whole group”: Applies to the Catatonia / Psychomotor Shutdown / Malignant Syndromes group — not specific to Catatonia in psychotic disorder

Why it fits

Psychosis plus marked motor syndrome

Key features

Must-not-miss

Violence in excited catatonia, profound immobility, refusal of intake, autonomic instability.

High-risk causes4 causes

Violence in excited catatonia
profound immobility
refusal of intake
autonomic instability

Bedside question

Applies to the Catatonia / Psychomotor Shutdown / Malignant Syndromes group.

Characteristic motor syndrome rather than simple low mood, psychosis, or "behavioural refusal". Mood disorders are a very common substrate.

Helpful clues

Immediate action

Applies to the Catatonia / Psychomotor Shutdown / Malignant Syndromes group.

Use structured screen (Bush-Francis), examine motor signs, check vitals/hydration/CK, think benzodiazepine challenge early Catatonia is more often mood-linked than many clinicians expect Treat the catatonia specifically Benzodiazepines and/or ECT are first-line Run a full delirium workup Hypoactive delirium is a major mimic

Priority steps6 steps

1Use structured screen (Bush-Francis), examine motor signs, check vitals/hydration/CK, think benzodiazepine challenge early
2Catatonia is more often mood-linked than many clinicians expect
3Treat the catatonia specifically
4Benzodiazepines and/or ECT are first-line
5Run a full delirium workup
6Hypoactive delirium is a major mimic

Investigations

Applies to the Catatonia / Psychomotor Shutdown / Malignant Syndromes group.

Vitals, oxygen saturation, Creatine kinase, Neuroimaging (CT/MRI), EEG, Lumbar puncture / CSF studies

Core tests5

Vitals, oxygen saturation
Creatine kinase
Neuroimaging (CT/MRI)
EEG
Lumbar puncture / CSF studies

Mimics / overlap

Applies to the Catatonia / Psychomotor Shutdown / Malignant Syndromes group.

None listed

Consider

Points for this presentation

Applies to the Catatonia / Psychomotor Shutdown / Malignant Syndromes group — not specific to Catatonia in psychotic disorder

Use structured screen (Bush-Francis), examine motor signs, check vitals/hydration/CK, think benzodiazepine challenge early
Catatonia is more often mood-linked than many clinicians expect
Treat the catatonia specifically
Benzodiazepines and/or ECT are first-line

First-line tests

Applies to the Catatonia / Psychomotor Shutdown / Malignant Syndromes group — not specific to Catatonia in psychotic disorder

Vitals, oxygen saturation
Creatine kinase
Neuroimaging (CT/MRI)
EEG
Lumbar puncture / CSF studies

Watch for

Violence in excited catatonia
profound immobility
refusal of intake
autonomic instability

Also consider

Source and review

Review due· Unverified

v10 · exported 2026-07-11

Clinical reference — not validated decision support. Review before use.